Vacation Bible School Mon., July 27– Thu July 30, 2015 9a.m.–12p.m. Friday, July 31, 2015 9am—12pm & *6—8pm *NEW Family VBS Review & Dinner Age 4 to Incoming Grade 5 *Early Discount—$30/child (sugg’d donation); $80/max.family *After July 10—$40/child & $90/max. family Financial assistance available First Presbyterian Church 150 S. Ashland Ave., La Grange www.fpclg.org / 708.354.0771 / [email protected] Please fill out both sides of the registration form (one form per family) and submit to the Church Office with check payable to FPCLG. Hurry! Registration closes when classes are full—class size is limited. Volunteers (Grade 6-Adult) please complete reverse side of the form. Parent/Adult Information: Name(s): ______________________________________________________ Address: ______________________________________________________ 1. Child’s Name: _____________________________________________ Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________ Food allergies or other medical concerns? No Yes (describe) _________________________________________________________ 2. Child’s Name: _____________________________________________ Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________ Food allergies or other medical concerns? No Yes (describe) _________________________________________________________ 3. Child’s Name: _____________________________________________ Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________ Food allergies or other medical concerns? No Yes (describe) _________________________________________________________ 4. Child’s Name: _____________________________________________ Grade – Fall ‘15:_____ Birth Date (Must be 4 by July 27): _________ Food allergies or other medical concerns? No Yes (describe) _________________________________________________________ City: ________________________________________ State: ___________ Emergency Information: Please list emergency information for your child(ren) in the event that you are not available. Home Phone: __________________ Alt. Phone: __________________ ____ Emergency Contact Person: _____________________________________ E-Mail Address: _________________________________________________ Home Phone: _____________________ Alt. Phone: _________________ Member of FPCLG: Yes No church affiliation No/Belong to (Church): _________________________________________ Please list names of other people who might be picking your child up at the end of the day (babysitter, neighbor, friend, etc.): ______________________________________________________________ In the event of an emergency, I give my permission for the Vacation Bible School volunteers to seek medical treatment for my child(ren). I further give permission to doctors and hospital staff to provide medical/surgical treatment necessary for my daughter/son. I understand I will be contacted as quickly as possible. I will contact Kevin Keely at 708.482.7568 or kevin.keely@ gmail.com if I have a concern about my child being photographed during VBS. Signature: X_______________________________ Date: _____________ This ministry is made possible only through the dedication of volunteers, like YOU. Please join our fun ‘Laboratory Team’! For ADULT Volunteer ‘Lab Assistants’: Your Name________________________________________ E-mail ____________________________________________ Phone #___________________________________________ Before VBS, I can: *Please note that, in accordance with our Child Protection Policy and for the safety of our children, training and background check are required for all applicable adult volunteers. Please see a VBS Team Member or contact the Church Office for more details. *Check here if you have had a background check as a volunteer or employee elsewhere and if you give us permission to contact them regarding the background check. Where? ________________ For YOUTH Volunteer ‘Lab Assistants’: Help with VBS Planning Help with decorations Your Name_____________________________________________ During VBS, I can (check all that apply): Grade—Fall ‘15: _______ Pray for children, leaders & parents Particular Area I’m interested in: ___________________________ Be a substitute ‘Lab Assistant’ I am available on (Circle all that apply): Assist as needed Monday Tuesday Wednesday Thursday Friday Lead or Assist (circle which) in a particular area (please specify): ________________________________________________________ ________________________________________________________ During VBS, I am available to help on (check all that apply): *MANDATORY VOLUNTEER ORIENTATION ON SUNDAY, JULY 26, 12:30 P.M. Monday Tuesday Wednesday Thursday Friday Office Use: Has Iron-on, CD & Songbook Signed & Gave E-mail Address Paid (cash or check # _________) Has Required Child Protection Policy Forms Form Entered